The comparison of the results of miniinvasive treatment of stress urinary incontinence using Ajust^TM and MiniArc^TM system

Czech version

Authors: Jan Krhut ^1,2; Alois Martan ³; Marcel Gärtner ⁴; Roman Zachoval ⁵; Kamil Švabík ³; Michal Halaška ⁶; Lukáš Horčička ⁷; Josef Tvrdík ⁸; Tomáš Hanuš ⁹
Authors‘ workplace: Katedra chirugických oborů LF OU Ostrava ¹; Urologické oddělení FN, Ostrava-Poruba ²; Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha ³; Gynekologicko-porodnická klinika FN Ostrava-Poruba ⁴; Urologické oddělení Fakultní Th omayerova nemocnice, Praha ⁵; Gynekologicko-porodnická klinika FN Bulovka a 1. LF UK, Praha ⁶; GONA spol. s r. o., Praha ⁷; Přírodovědecká fakulta OU, Ostrava ⁸; Urologická klinika 1. LF UK a VFN, Praha ⁹
Published in: Ces Urol 2012; 16(1): 20-28
Category: Original article

Overview

Aim:
The aim of the study was to compare the effectiveness of two minimally invasive surgical techniques for stress urinary incontinence in female patients (Ajust^TMand MiniArc^TM), using subjective assessment as well as evaluation of objective parameters.

Methods:
A total of sixty-six female patients with stress urinary incontinence were enrolled into the prospective, randomized, multicentre trial, mean age 57.8 years (range 42–88 years). Patients in Group A had undergone surgery using Ajust^TMmethod; patients in Group B underwent surgery using the MiniArc^TMmethod.

The subjective satisfaction of the patients along with the outcome of the procedure was evaluated using a standardized questionnaire “The International Consultation on Incontinence (ICI-Q)”. The objective assessment was performed with the use of cough test, urodynamics (bladder volume at the first desire to void – FDV, cytometric capacity – CC, maximum urethral closure pressure – MUCP, maximum urinary flow – Qmax), and ultrasound parameters (difference between the gamma –gamma_difangles, distance between vesicourethral junction at rest and during the Valsalva maneuver – d). All of the parameters were measured prior to treatment, and three months following the surgical procedure. Statistical evaluation was performed with the two-choice t-testand nonparametric two-choice Wilcoxon’s test, with the correction for sequence alignment.

Results:
When assessing the subjective satisfaction ofthe procedure, we found, that both groups of patients reported a significant improvement in the total score (-14.09 ± 5.18 vs. -14.45 ±3.73), no significant difference was observed between the two methods (p = 0.74569). Objective assessment of the surgical procedure documented a lack of incontinence in a total of 61 patients (92.43%) following surgery. These included 31 patients (94%) from Group A and 30 patients from Group B (91%).

When we compared the urodynamic parameters before and after the surgery, we observed a significant increase of the cytometric capacity in patients of Group B. No other statistically significant differences between these two surgical procedures were observed in the other parameters.

A clear decrease in the uretrovesical junction mobility was observed in comparison with the pre-surgery measurements using introital sonography. We observed a decrease in the gamma angle (-13.82 ± 21.63 vs. -9.82 ± 17.17), as well as a shortening of the d line segment (-3.75 ± 6.93 vs. -3.53 ± 5.53). No statistically significant differences were observed between both methods of surgical treatment.

Conclusion:
Our initial experience with the surgical techniques Ajust^TMand MiniArc^TM, with respect to the effectiveness and possible per- or postoperative complications, are good. From our assessment carried out at three-month follow up after the surgery it is apparent that the effectiveness of both surgical procedures are comparable. However, further follow-up is necessary for a definitive assessment of both methods.

Key words:
stress urinary incontinence, surgical treatment, minisling, Ajust^TM, MiniArc^TM.

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